Simulation Exercise Gives Med Students Feel for Surgery Technique

The 36 first-year medical students who took part in a surgery simulation exercise offered by the department of orthopaedic surgery, in conjunction with Einstein's Orthopaedic Surgery Interest Group (OSIG), will never look at a grapefruit the same again.

Recently, in a conference room on the eleventh floor of 1250 Waters Place, the students gathered around a table as Dr. I. Martin Levy, professor of clinical orthopaedic surgery at Einstein and attending orthopaedic surgeon at Montefiore, discussed arthroscopy with them. Dr. Levy described how this form of surgery has evolved from a diagnostic tool when it was introduced in the 1970s to a sophisticated surgical tool that is even being used for reconstructive surgery today.

He showed the students pictures of early instruments and discussed how the telescopes used in arthroscopic surgery have evolved. "In the days of the dinosaurs when I started, we worked with a three-pound camera," he said. "They now weigh just ounces."

A Different Way of Seeing

As he prepared the students for their surgery simulation exercise he reminded them, "With this kind of surgery, you're not looking at what you're operating on. You're working off the field, using triangulation to process what you see on the monitor and determine what you need to do."

He and chief resident for orthopaedic surgery, Dr. Jonathan Krystal, then took six of the students across the hall where the grapefruits came into play. Three of the large citrus fruit had been prepped for surgery, waiting to have their seeds removed arthroscopically.

The two surgeons made the initial incisions on each fruit—one for inserting the endoscopic instrument with its tiny, nearly weightless camera, and the other for inserting the grasping tool that the students would use to remove seeds from their juicy orb.

"Find the pits, take 'em out and celebrate wildly," instructed Dr. Levy.

Challenging Technique to Master

He added, "It's a fairly difficult skill to master, because you need to be able to put the instrument in the right place while holding the camera steady. Orienting yourself and coordinating your handwork in a space that's no more than five millimeters takes practice. Working with a grapefruit puts you into that kind of a confined area, and the multitude of seeds offers lots of opportunities to work with the tools."

As students completed their session with the grapefruit, they conferred over how many seeds each had gotten. "I got three," said Jacob Taylor, "but I was only able to get two of them all of the way out. Still, it felt great to do even those. You get a real sense of accomplishment."

"The most difficult part was orienting your movements to what you saw on the screen," added classmate Hope Williams, to agreement from all the students from their group.

Providing Memorable Experiences

"Our interest group seeks to provide ways that students can learn about and experience different aspects of orthopaedic surgery, said Stephen Sylvia, president of OSIG. "This experience gave us a real feel for a skill that's particularly important for those interested in orthopaedics to master."

"This type of surgery isn't for everyone," noted Dr. Levy. "But not being able to master the technique doesn't rule out surgery as a career path. Open surgery involves a different set of skills, for example. An exercise like this allows students and residents to experience a particular tool skill and work at mastering it."

Dr. I. Martin Levy offers guidance to OSIG chair Stephen Sylvia

Students awaiting their turn watch the progress of their classmates

In the exercise, students attempt to grasp seeds from within the grapefruit and remove them